A new technique for proximal femoral resection in non-ambulatory patients with cerebral palsy.

Proximal femoral resection may be proposed to non-ambulatory patients with cerebral palsy and chronic painful hip dislocation. McCarthy's technique confers good results but does not solve the problems related to femoral reascension (bone migration causing painful osseous or cutaneous conflict). We describe a new technique of resection-interposition of the proximal end of the femur which preserves the greater trochanter by an orthogonal osteotomy below the lesser trochanter while maintaining the gluteal-vastus lateralis strut in continuity. A suture of the remaining joint capsule upon itself and a trans-trochanteric capsulodesis are associated to stabilize the cephalic displacement of the femur.

Is there a persistent capital femoral epiphysis growth after screw fixation for slipped capital femoral epiphysis?

Femoral neck screwing during child development is controversial. The objective of this study was to evaluate the residual growth of the capital femoral physis after screw fixation. This retrospective study included children aged younger than 12 years treated for slipped capital femoral epiphysis (SCFE) with a single percutaneous partially threaded cannulated screw. The children were followed up for at least 1 year. Some patients also underwent prophylactic contralateral screwing. Preoperative, immediate postoperative and final follow-up X-rays were evaluated to determine the degree of slippage, pin-joint ratio (PJR), neck-pin ratio (NPR), number of threads crossing the physis, neck-shaft angle (NSA), screw-physis angle and screw position in the physis. We included 17 patients (29 hips: 18 SCFE and 11 prophylactic) with a mean age of 10.1 years (range: 7.1-11.9 years) at the time of surgery. Significant evolution of radiological growth parameters of the proximal femoral physis was noted during a mean follow-up of 2.4 years (range: 1-4.3 years). The mean PJR significantly decreased from 7.3 to 6.0, the mean NPR significantly decreased from 106 to 96 and the mean number of threads beyond the physis decreased from 3.3 to 1.8. The mean NSA decreased by 6.5°, from 139° to 132.5°. Persistent capital femoral epiphysis growth occurs after screw fixation. The NSA significantly decreases over time but remains within the physiological limits. Level of evidence: IV (case series).

Acetabular retroversion after triple pelvic osteotomy for Legg-Calvé-Perthes disease and its impact on the femoroacetabular impingement: a case/control study at 15 years of follow-up.

The objective of this study was to compare the effect of triple pelvic osteotomy (TPO) in Legg-Calvé-Perthes disease (LCPD) on acetabular version in a group of patients who developed a femoroacetabular impingement (FAI) and a control group without FAI. Patients who received a TPO for unilateral LCPD were retrospectively included. Patients with bilateral LCPDs, requiring TPO with femoral procedures, or with incomplete imaging were excluded. Seven patients with FAI (FAI+) and eight patients without FAI (FAI-) were evaluated at a mean follow-up of 14.8 years. The two groups were comparable in demographic data, age at diagnosis, Herring score, and BMI. We measured anatomical acetabular version on computed tomography scans, the difference (delta) of acetabular version between the operated hip and the healthy hip, the McKibbin (femoral version + acetabular version), Stulberg, and Tönnis scoring system. The two groups were not statistically different on the Stulberg and Tönnis scores. All operated hip acetabula were retroverted, FAI+: -8.41° (range, -44 to 10.5), FAI-: -3.38° (range, -37.3 to 11.5) (P = 0.61). The average delta was FAI+: 23.79° (range, 1.5-59.5), FAI-: 20.14° (range, 5-45.3) (P = 0.68). All seven patients of the FAI+ group have pathologic McKibbin index (<30°) versus only four of the FAI- group (P = 0.03). TPO induces acetabular retroversion in patients with LCPD. This retroversion, assessed in a static benchmark (anterior pelvic plane), does not in itself explain the FAI.